大量产后出血的危险因素分析

Analysis of the risk factors for massive postpartum hemorrhage

目的研究与大量产后出血相关的危险因素。方法回顾分析该院2016年1月至2017年12月发生产后出血的182例孕产妇临床资料。将产后24 h内出血量大于或等于1500 mL定义为大量产后出血,采用单因素分析法分析与大量产后出血相关的危险因素,应用多因素logistic回归分析法评估各项危险因素。结果182例产后出血病例中,大量产后出血77例,发生率为42.31%;77例均需要输血治疗,其中6例行子宫切除。单因素分析显示年龄、孕次、产次、流产次数、剖宫产史、妊娠期间阴道流血、妊娠期间硫酸镁治疗、妊娠合并前置胎盘、前置胎盘合并瘢痕子宫、终止妊娠时孕周和胎盘异常种植等11项因素与大量产后出血相关(P<0.05);logistic多因素回归分析表明:剖宫产史和妊娠合并前置胎盘是大量产后出血的独立危险因素(P<0.05)。结论减少重复人流、严控首次剖宫产率有助于减少大量产后出血的发生。

Objective To explore the risk factors of massive postpartum hemorrhage.Methods A retrospective analysis of the clinical data of 182 pregnant women with postpartum hemorrhage occurred in the hospital from January 2016 to December 2017.Massive postpartum hemorrhage was defined as postpartum hemorrhage≥1500 mL within 24 hours after delivery.The single-factor analysis was used to analyze the high-risk risk factors associated with massive postpartum hemorrhage.Multivariate logistic regression analysis was used to evaluate the high-risk factors.Results Among the 182 cases of postpartum hemorrhage,77 cases of massive postpartum hemorrhage occurred,the incidence rate was 42.31%.All the 77 cases required blood transfusion treatment,6 cases of hysterectomy.Univariate analysis showed that the risk factors significantly related to massive postpartum hemorrhage were as follows:maternal age,pregnancies,parity,number of abortions,history of cesarean section,vaginal bleeding during pregnancy,treatment with magnesium sulfate,placenta previa,placenta previa with scar uterus,termination of gestational gestational weeks,relationship between placenta and uterus(P<0.05).Logistic multivariate regression analysis showed that previous cesarean section and pregnancy combined with placenta previa were independent risk factors for massive postpartum hemorrhage(P<0.05).Conclusion Reducing repeated abortions and strictly controlling the rate of cesarean section could help reduce the incidence of severe postpartum hemorrhage.